OA

Shoulder Osteoarthritis

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Shoulder Osteoarthritis, Degenerative Joint Disease of the Shoulder, Shoulder DJD, Glenohumeral Arthritis, Glenohumeral Osteoarthritis, Shoulder Arthritis

  • See Also
  • Causes
  1. Primary Shoulder Osteoarthritis (Idiopathic)
  2. Secondary Shoulder Osteoarthritis due to Atraumatic Osteonecrosis
    1. Toxins (e.g. Alcohol Abuse, Corticosteroids, specific cytotoxins, radiation)
    2. Obesity
    3. Lysosomal Storage Disease (e.g. Gaucher's Disease)
    4. Sickle Cell Anemia
  3. Secondary Shoulder Osteoarthritis due to Inflammation
    1. Gout, Pseudogout or other crystal Arthropathy
    2. Following Septic Arthritis
    3. Rheumatoid Arthritis
    4. Rotator Cuff Injury
  4. Secondary Shoulder Osteoarthritis due to Surgery or Trauma
    1. Shoulder Dislocation or Shoulder Subluxation
    2. Prior Proximal Humerus Fracture with malunion
    3. Avascular necrosis
    4. Prior surgery with complications related to hardware, capsulorrhaphy, capsule tightening
  • Epidemiology
  1. Less common site for osteoarthritic changes
  2. Age of onset typically >50 years old
  • Risk Factors
  1. Chronic rotator cuff disease
  2. Recurrent Shoulder Dislocations
  3. Severe ShoulderFractures
  4. Prior Shoulder surgery
  • Symptoms
  1. Gradual onset of pain and stiffness
  2. Stiffness may significantly limit function when advanced
  3. Chronic Shoulder Pain
  4. Crepitus
  • Signs
  1. Limited Shoulder Range of Motion - active and passive
  • Imaging
  1. See Shoulder XRay
  2. Signs of Osteoarthritis on XRay: Degenerative changes
    1. Axillary view best demonstrates joint space narrowing
    2. Subchondral sclerosis and osteophytes may also be seen
  • Management
  1. Analgesics
    1. Acetaminophen 1000 mg orally 2 to 4 times daily
    2. NSAIDs
  2. Supplements
    1. Glucosamine 500 mg orally three times daily
  3. Shoulder Intraarticular Corticosteroid Injection
    1. Consider in refractory cases, but studies do not show significant benefit
  4. Physical Therapy
    1. Avoid aggressive therapy (may exacerbate Osteoarthritis)
    2. Goal is to maintain function and pain control
  • Management
  • Surgical intervention in severe or refractory cases
  1. Joint preservation surgery (in early disease and young patients under age 60)
    1. Arthroscopic glenohumeral debridement and capsular release (most common)
    2. Corrective osteotomies
    3. Interposition arthroplasty
  2. More aggressive surgical interventions for severe Osteoarthritis
    1. Arthrodesis (fusion of humeral head to glenoid) for severe cases under age 50 years
    2. Hemiarthroplasty (Humerus replacement only)
    3. Total Shoulder Arthroplasty
  • Prevention
  1. Control comorbid conditions (e.g. Diabetes Mellitus)